Abstract: Objective To observe the clinical effect of the "Z"-shaped single purse-string suture method for the treatment of severe hemorrhoids with mucosal resection and nailing of hemorrhoids.Methods A total of 114 patients with stage Ⅲ or Ⅳ internal hemorrhoids,and mixed hemorrhoids who underwent hemorrhoidal mucosal resection and nailing surgery between March 2020 and February 2024 were selected and randomly divided into three groups using a random number table method,with 38 cases in each group.Single purse-string suture method was used for the patients of control group A,double purse-string suture method was used for the patients of control group B,and "Z" - shaped single purse-string suture method was used for the patients of observation group.The intraoperative conditions (surgical time,tissue resection width,incidence of intraoperative hematoma),incidence of postoperative complications (pain,heavy bleeding,anal prolapse,anal stenosis),and recurrence of hemorrhoids within 6 months after surgery were compared among three groups.Results The surgical time of the observation group was (25.34±6.61) minutes,which was significantly lower than that of the control group B [(32.13±6.51) minutes] (P<0.05),and there was no significant difference between the observation group and control group A [(24.47±5.76) minutes] (P>0.05).The width of the excised tissue in the observation group [(2.53±0.35) cm] was significantly larger than that of the control group A[(2.13±0.36) cm] (P<0.05),and there was no significant difference between the observation group and control group B [(2.62±0.40)cm] (P>0.05).The incidence of intraoperative hematoma in the observation group was 15.79% (5/38),which was significantly lower than that of the control group B [42.11 (16/38)] (P<0.05),and there was no significant difference between the observation group and control group A [13.16% (5/38)] (P>0.05).There was no statistically significant difference (P>0.05) in the incidence of postoperative pain,heavy bleeding,anal prolapse,and anal stenosis among the three groups.Follow up until 6 months after surgery,there were no recurrence cases in the observation group and control group B,which was significantly lower than that in control group A [5.71% (2/35)](P<0.05).Conclusion The "Z" - shaped single purse-string suture method is simple to operate,has a short surgical time,removes wide tissue,and does not increase complications.

Key words: Z shape, purse stitching, hemorrhoid mucosal resection and anastomosis, hemorrhoids surgery